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153 0- N + o (jjw LO;: N~ ...... >- Z I- ffi$ :; en ro <C ~u.. C '3(/)wU:: g...."u. 1J5Q)~<c z c~ Q.-;:: ~ g Iii ro ~ ffi~t5 II: W el.... ~o ~"O ::l!C 15~ w"O ~o \20 ~~ W ~LO II:...... ~ a:.' ;:: ~ en :Ii ffi ~ II: Cl Cl z Cl <( <( .... !!; ~ ~ t; 0- en + ~f:i W ::l!::Q ~~5 !;i Iii~~ 0 ::lOW ~~g u:: ~~15 ~ [oen W 0....>- w~<3 0 b~'" Z:J~ COUNTY Dutchess CITYfTOWN Wappmger DISTRICT1368 ' NUMBER REGISTER 153 NUMBER STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM Adam Steven Halliday MIDDLE CURRENT SURNAME I STATE FILE NUMBER (THIS SPACE FOR STATE USE ONL Y) I L 0 SUPPLEMENTAL FILE FROM THE BRIDE Elizabeth Marie DePaolo ~ 1. A. FULL NAME 11. A, FULL NAME FIRST MIDDLE CURRENT SURNAME FIRST B, BIRTH NAME, IF DIFFERENT B, BIRTH NAME (MAIDEN NAME), IF DIFFERENT C, SURNAME AFTER MARRIAGE (OPTIONAL - SEE REVERSEb58_80_2368 D, SOCIAL SECURI1Y NUMBER 2, RESIDENCE A NY B. Dutchess (STATE) J... (COUNTY) C, CHECK ONE 0 CITY '"U TOWN 0 VILLAGE AND P hk . SPECIFY oug eepsle D, STREET ADDRESS 15 Woodland Dr ZIP 12590 E, is RESiDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO 04 /14 /1990 DAY YEAR C, SURNAME AFTER MARRIAGE (OPTIONAL - SEE REVERSE)132_80_5646 D, SOCIAL SECURITY NUMBER 12 RESIDENCEA,NY BDutchess (STATE) ~ (COUNTY) C, CHECK ONE [J CITY L,J TOWN 0 VILLAGE ~~~CIFY poughKeepsie D, STREET ADDRESS 15 Woodland Dr ZIP 12590 DYES [] NO )'993 E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 13, A, AGE 17 13B.DATE OF BIRTH 04 ~3 3, A, AGE 20 YEAR MONTH DAY 3B, DATE OF BIRTH MONTH 14, EMPLOYMENT A, USUAL OCCUPATION Student B, TYPE OF INDUSTRY OR BUSINESS Student 15, PLACE OF BIRTH Poughkeepsie, New York (CITY, STATE / COUNTRY IF NOT USA) 16, FATHER A, NAME Frederick Joseph DePaolo 'B, COUNTRY OF BIRTHU S A 17, MOTHER A, MAIDEN NAME Cheryl Ann Hodges B, COUNTRY OF BIRTHU S A 18, NUMBER OF THIS MARRIAGE 1 19, PREVIOUS MARRIAGES A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DOORCE CIVIL A1)ULMENT D~TH 4, EMPLOYMENT A, USUAL OCCUPATION Food Service B, TYPE OF INDUSTRY OR BUSINESS Food Service 5, PLACE OF BIRTH poughkeepsie, New York (CITY, STATE / COUNTRY IF NOT USA) 6, FATHER A, NAME John Paul Halliday B. COUNTRY OF BIRTH USA 7, MOTHER A, MAIDEN NAME Anne Elizabeth Homan B, COUNTRY OF BIRTH USA 8, NUMBER OF THIS MARRIAGE 1 9, PREVIOUS MARRIAGES A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT o 0 DEATH o B, HOW DID LAST MARRIAGE END? (3) 0 DIVORCE C, DATE LAST MARRIAGE ENDED? (3) 0 ANNULMENT / / (2) 0 DEATH B, HOW DID LAST MARRIAGE END? (3) 0 DIVORCE C, DATE LAST MARRIAGE ENDED? (3) 0 ANNULMENT (2) 0 DEATH / / ~ YEAR MONTH DAY D, ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO " 20, IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION DATE OF DECREE PLACE ISSUED AGAINST WHOM (MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE MONTH DAY YEAR D, ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO 10, iF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION DATE OF DECREE PLACE ISSUED AGAiNST WHOM (MONTH, DAY, YEAR) ICITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE o 0 1ST o 0 2ND o 0 3RD o 0 4TH o edge and belief that the information I provided is true an , o o o 21, SIGNATURE OF GROOM. ' USE U 23, SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME SIGNATURE OF TOWN OR CITY CLERK ~ by New York Domestic w en z w o ::l This license authorizes the marriage in New York State of the bride and groom named above by any person authorized Relations Law ~11 to perform marriage ceremonies within New York State, THIS LICENSE VALID IN NEW YORK STATE ONLY. o If checked, this license is to be used only for the purpose of a second or subsequent ceremony, ~ 24, TOWN OR CITY <:iLERI<,... M t 25, A, SOLEMNIZATION PERIOD BEGINS NAME (PRINT) JOnn li. as erson {SEAL} SIGNATURE ~ MA~~lOO~M '-.t-I 01 TIME MONTH YEAR MONTH YEAR DATE 11/05/201 0 sh Rd, Wappingers Falls, NY 12590 04 2011 AM 11 01 :01 PM 06 2010 ZIP STREET I CERTIFY THAT I SOLEMNIZED THE MARRIAGE OF THE PER- SONS NAMED ABOVE ON THE DATE AND AT THE TIME AND PLACE INDiCATED, STATE 27, TYPE OF CEREMONY o ~ RELIGIOUS 9 0 OTHER, SPECIFY 10 CIVIL A, STATE NEW YORK B, COUNTY b \H(C II (; 5 5 C, LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) o CITY OF ,0"TOWN 0 V LLA9F - ,~ ~ I SPECIFY ' ' 28, PLACE WHERE MARRIAGE OCCURRED TITLE 111 tJ 10 DATE / d- - '-I -:;1.0 tD ')If).. J J.-IoDC-F:3 ~ ~'~I:L CITYfTOWN 30, WITNESS TO CE!jE~ONY e~ . ) NAME.(PRINT) ~-e. 'go tJ SIGNATURE~ ~ Pt?1~~ DOH-98 (09/2009) STATE ZIP 31, WITNESS TO CEREMONY NAME(PRINT) j)u,,(d .~,k("l."tf'i SIGNATURE~ ,.lJ t-I.,u,,//'p .~..~.